Cost-effectiveness of multitarget stool DNA testing for colorectal cancer screening in Chinese primary healthcare settings: a modelling study

Aim: To evaluate the cost-effectiveness of a one-time mt-sDNA-based colorectal cancer screening program compared with no screening, using real-world data from a government-led population-based screening program in Harbin Municipality of China. Methods: This modelling study was based on a real-world mt-sDNA CRC screening program in Chinese primary healthcare settings. The program targeted residents aged 45–64 years without a prior history of CRC. A decision analytic model was developed from the healthcare system perspective to compare mt-sDNA screening with a hypothetical no-screening scenario. Costs included mt-sDNA testing, diagnostic colonoscopy after positive results, adenoma resection, and colorectal cancer treatment by disease stage. Effectiveness was measured in quality-adjusted life-years (QALYs). The primary outcome was the incremental cost-effectiveness ratio (ICER), assessed against a willingness-to-pay threshold of CNY 166,744 per QALY gained. Costs and QALYs were discounted at 5% annually over a lifetime horizon. One-way deterministic sensitivity analysis and probabilistic sensitivity analysis with 10,000 simulations were conducted. Results: Among 749,517 participants, 79,169 had positive mt-sDNA results and 17,364 completed diagnostic colonoscopy, corresponding to a colonoscopy adherence rate of 21.93%. In the base-case analysis, mt-sDNA screening incurred CNY 264 higher lifetime costs and yielded an additional 0.006 QALYs per person versus no screening. The mt-sDNA screening was cost-effective with an ICER of CNY 43,627 per QALY gained. The cost-effectiveness results were particularly sensitive to colonoscopy adherence (ranging from CNY 94,907 to 10,037 per QALY as adherence varied from 10% to 100%) and to the unit cost of the mt-sDNA test (ranging from CNY 22,113 to 65,140 per QALY with a ± 50% variation in cost). All ICERs remained below the cost-effectiveness threshold. Conclusions: The mt-sDNA screening is cost-effective compared to no screening. These findings provide economic evidence to support the large-scale adoption of mt-sDNA-based screening in China.